Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.
 ...
PMID:Constrictive pericarditis after myocardial revascularization: report of three cases. 31 49

Human allograft bypass of the failing left ventricle is an efficient and practical way of effecting short-term improvement in the overall hemodynamic status of patients. It is suggested that controlled sequential pacing of the donor heart would improve the overall hemodynamic result and better preserve function of the bypassed ventricle. Simultaneous bypass of the right ventricle might prevent the acute right heart failure seen during serious ventricular arrhythmias occurring in the recipient heart. Future indications for the technique in modified form could include severe biventricular failure and acute reversible forms of heart failure.
 ...
PMID:Left ventricular bypass using a cardiac allograft: hemodynamic studies. 77 61

Because it is sometimes difficult to determine the cause of hypotension in patients after cardiac operations, we assessed the value of transesophageal echocardiography in this respect, and we studied 60 consecutive patients who had hypotension despite positive inotropic medication and, in some patients, mechanical support. Echocardiographic diagnoses were compared with diagnoses based on hemodynamic parameters. Follow-up examinations were completed in all patients to confirm the final diagnoses. Echocardiographic signs of hypovolemia were present in 14 patients, tamponade in six, left ventricular failure in 16, right ventricular failure in 11, and biventricular failure in eight. Echocardiographic examination proved to be inconclusive in five patients. Comparison with hemodynamic parameters showed agreement on diagnoses (hypovolemia versus tamponade versus cardiac failure) in 30 patients (50%). Echocardiography correctly identified two patients with tamponade and six with hypovolemia; these conditions were not suspected by standard hemodynamic data; in five patients unnecessary reoperation was prevented, although hemodynamic values were suggestive of tamponade. Echocardiography also identified subcategories of patients at high risk of death (those with signs of right ventricular and biventricular failure). These findings suggest that transesophageal echocardiography performed on patients after cardiac operations, at the bedside in the intensive care unit, can readily elucidate the cause of hypotension in the large majority of patients and is a valuable adjunct to hemodynamic evaluation in patient management. Furthermore, it appears to be possible to identify subcategories of high-risk patients, based on these echocardiographic findings.
 ...
PMID:Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters. 149 93

Heart transplantation is the procedure of choice for patients with severe congestive heart failure, but many patients are not candidates because of associated medical problems and the lack of donor hearts. Since 1988 we have performed 36 heart transplantations. One and 2-year actuarial survival rates have been 82% and 73%. Sixteen patients who were not candidates for heart transplantation have undergone cardiomyoplasty, a procedure in which the left latissimus dorsi is transposed to the myocardium and paced synchronously with the heart to augment cardiac function. The average age was 55 years (range, 39 to 65 years). Preoperative left and right ejection fractions were 24.9% +/- 2.1% and 43% +/- 4.5%. Eleven patients were in the New York Heart Association class IV, and five patients were in class III. Four operative deaths occurred, and three additional deaths occurred within 6 months of surgery. Nine patients became long-term survivors, and seven of nine patients are alive at a mean follow-up of 29 months. All patients are in New York Heart Association class I or II. In long-term survivors, mean left ventricular ejection fraction increased from 24.9% +/- 2.1% to 31.8% +/- 3.5% (p less than 0.01). All but one of the operative and early deaths occurred in patients with biventricular failure (n = 6). One operative death and no early deaths occurred in patients with normal right ventricular ejection fraction. This initial experience suggests that cardiomyoplasty may be helpful for heart failure patients with preserved right ventricular function, but heart transplantation should be the therapy of choice for biventricular failure.
 ...
PMID:Surgical therapy for congestive heart failure: indications for transplantation versus cardiomyoplasty. 161 Aug 61

Options for mechanical support of pediatric patients with severe heart failure who are awaiting transplantation or have undergone transplantation are limited. This report examines 3 patients placed on extracorporeal life support (ECLS) while awaiting transplantation and 3 patients who underwent transplantation and suffered subsequent heart failure due to rejection or postoperative myocardial dysfunction. The overall survival rate was 2 of 6. The 2 surviving patients had a failing transplanted heart. There were no survivors among the patients placed on ECLS as a bridge to transplantation. In each case a contraindication to transplantation developed before a donor heart could be obtained. The mean time of ECLS support was 147.5 hours (range, 70 to 370 hours). The ECLS circuit did not affect cyclosporin levels or antirejection therapy. Extracorporeal life support can be used to support pediatric cardiac transplant patients with biventricular failure due to acute rejection or postoperative dysfunction. Although the results have been discouraging, ECLS may still have a role as a bridge to transplantation. However, complications can develop during ECLS that may preclude transplantation.
 ...
PMID:Prolonged extracorporeal life support of pediatric and adolescent cardiac transplant patients. 224 45

We report a case of successful biventricular assist for severe heart failure after open heart surgery. A 62-year-old man suffering from advanced valvular disease accompanied with hepatorenal dysfunction underwent mitral valve replacement and tricuspid annuloplasty on September 22, 1988. Because of inability of weaning from cardiopulmonary bypass, left heart assisted circulation using a roller pump with heparin-coated tubing system was inserted. Following the left heart assist, an right ventricular assist device (RVAD) was subsequently applied to intractable right ventricular failure. He was successfully weaned from an RVAD after 24 hours, and from left heart assisted circulation after 46 hours. At present, he is doing well without significant complications. Earlier application of biventricular assist might be effective for biventricular failure with hepatorenal dysfunction.
 ...
PMID:[A successful biventricular assist for postoperative patient with severe heart failure and hepatorenal dysfunction after mitral and tricuspid valve surgery]. 261 28

Three patients with biventricular failure were managed postoperatively with the aid of a right ventricular assist device (RVAD) and intraaortic balloon pumping (IABP) with favorable results. Among these three cases, two had multiple rheumatic valvular disease with cardiac cachexia and underwent combined valve replacement. Another who was suffered from heart failure with a large ventricular septal defect and tricuspid regurgitation had a VSD closure and tricuspid valve replacement. In all patients, the weaning from pump oxygenator was difficult even with large doses of catecholamine. Therefore, the pump oxygenator was switched to RVAD for right ventricular assistance and IABP for left ventricular assistance because these patients had had right ventricular failure dominant biventricular failure preoperatively. Though case 2 was lost 64 days after the surgery by retroperitoneal bleeding due to inadequate anticoagulant treatment, the other two cases recovered successfully from postoperative biventricular failure and were discharged from the hospital. The indications of this method and the criteria for RVAD weaning were discussed.
 ...
PMID:[A case report of biventricular assistance by means of ventricular assist device and IABP in postoperative biventricular failure]. 280 1

Plasma atrial natriuretic peptide levels are increased in heart failure. In rats with experimental heart failure, the elevation in plasma atrial natriuretic peptide bore a close relationship to the size of the myocardial infarct and the degree of ventricular dysfunction. Sodium retention, assessed by changes in exchangeable body sodium, could not be demonstrated in this model of cardiac dysfunction. Even rats receiving a low-sodium diet had increased plasma atrial natriuretic peptide levels following coronary artery ligation despite a significant decrease in exchangeable body sodium. This establishes that the elevated plasma atrial natriuretic peptide levels found in heart failure are a consequence of ventricular dysfunction and increased intracardiac pressures rather than a reflection of the salt and water status. Alternatively, the elevated plasma atrial natriuretic peptide may limit salt and water retention in this model. In these animals with high circulating atrial natriuretic peptide levels, "down-regulation" of renal atrial natriuretic peptide receptors could be demonstrated. This decrease in renal atrial natriuretic peptide receptor numbers may, in part, explain the blunted response to infused atrial natriuretic peptide in heart failure. However, changes in renal atrial natriuretic peptide receptors alone would appear to be insufficient to lead to salt and water retention without the activation of other sodium-retaining mechanisms that occur with the progression of cardiac failure. Nevertheless, this down-regulation of renal atrial natriuretic peptide may then contribute to the salt and water retention that occurs in congestive biventricular heart failure. The close relationship between increases in atrial natriuretic peptide and ventricular dysfunction rather than sodium balance suggests that atrial natriuretic peptide's primary role in the circulation may be to produce venodilation and increase capillary permeability. This may act rapidly to reduce cardiac preload and prevent pulmonary congestion. Vasodilation and natriuresis may then become supplementary actions to maintain cardiac output and remove the excess fluid.
 ...
PMID:Regulation of cardiac preload by atrial natriuretic peptide in congestive cardiac failure. 285 Dec 66

On the basis of both experimental and clinical studies it is not clear whether left, right, or biventricular heart failure are necessary for the formation of pleural effusions. In order to study the relationship of pulmonary hemodynamics and the presence of pleural effusions in patients with congestive heart failure, we prospectively evaluated 37 patients admitted to the coronary care unit with congestive heart failure secondary to ischemic heart disease or a cardiomyopathy. We used real-time ultrasonography to document the presence of pleural effusions. We found that 19 of the 37 patients with heart failure had pleural effusions. Mean pulmonary artery wedge pressure was 24.1 +/- 1.3 mmHg (SE) in the 19 patients with pleural effusions versus 17.2 +/- 1.5 mmHg (SE) (p less than 0.001) in the 18 patients without pleural effusions. Pulmonary artery pressure was also higher in patients with pleural effusions with a mean value of 38.0 +/- 1.5 mmHg (SE) versus 30.7 +/- 2.1 mmHg (SE) (p less than 0.05) in the patients without pleural effusions. In contrast, mean right atrial pressure was not different between patients with pleural effusions (12.6 +/- 1.5 mmHg) (SE) versus those without pleural effusions (9.8 +/- 1.0 mmHg) (SE) (p = NS). In addition, there was no difference in cardiac output, pulmonary vascular resistance, or total protein concentrations between patients with and without pleural effusions. We conclude that, in patients with congestive heart failure, an elevated left atrial pressure is closely correlated with the presence of pleural effusions, while concurrent elevation of right atrial pressure is not associated with the presence of pleural effusions.
 ...
PMID:Relationship of pleural effusions to pulmonary hemodynamics in patients with congestive heart failure. 390 44

The reversibility of the abnormalities in arterial baroreceptor control of heart rate in heart failure was examined in an experimental model of canine high-output biventricular failure produced by an arteriovenous fistula that could be later surgically corrected by ligation. Marked attenuation of arterial baroreceptor control of heart rate in response to both hypertensive and hypotensive stimuli was seen in this model of heart failure. After surgical correction the heart rate response to a hypertensive stimulus did not return to normal but remained severely blunted for up to 8 mo of follow-up. The lack of reversibility after surgical correction suggests that permanent structural changes in arterial baroreceptors may occur after heart failure of short duration.
 ...
PMID:Reversibility of abnormal arterial baroreflex control of heart rate in heart failure. 679 39


1 2 3 4 5 6 7 8 9 10 Next >>